BACKGROUND
Recent evidence suggests that digital adherence technologies (DATs) can be useful supporting tuberculosis (TB) medication adherence. However, given that TB is well known to be a disease of poverty, lack of money may potentially limit the usefulness of DATs (e.g., the inability to afford transportation to pick up the medications). Complementing DATs with Mobile Money-delivered financial incentives may improve their utility, yet the feasibility and acceptability of integrating economic support with a DATs intervention for TB medication remain unclear.
OBJECTIVE
To describe the feasibility and acceptability for a novel DATs intervention called My Mobile Wallet composed of real-time adherence monitoring, SMS reminders, and Mobile Money incentives for TB medication adherence in a low-income setting.
METHODS
We purposively recruited people living with TB from Mbarara Regional Referral Hospital who were; a) starting TB treatment at enrollment or within the past 2 weeks, b) owning a mobile phone, c) able to use SMS, d) aged 18 years and older, and e) living in Mbarara District. At study exit (month 6), we used interviews and questionnaires informed by the Unified Theory of Acceptance and Use of Technology to collect feasibility and acceptability data, reflecting patients’ experiences of using each component of the My Mobile Wallet intervention. Feasibility also included tracking functionality of the adherence monitor (i.e. an electronic pillbox) and SMS and Mobile Money delivery. We used content analytical approach to inductively analyze qualitative data and STATA 13 to analyze quantitative data.
RESULTS
All 39 participants reported that the intervention was feasible as it was easy for them to use (e.g., access and read SMS texts) and worked as expected. Almost all the SMS texts (n=6880; 97%) were sent as planned. The transmission of adherence data from the monitor worked well with 98% of data transmitted as planned. All participants additionally reported that the intervention was acceptable as it helped them take their TB medication as prescribed: Mobile Money incentives relieved participants of TB-related financial burdens; SMS reminders and electronic pillbox -based alarms reminded participants to take their medication on time; participants perceived real-time adherence monitoring as being watched while taking medication, which encouraged them to take medication on time to demonstrate their commitment. The intervention was perceived as a sign of care which eventually created emotional support and a sense of connectedness to healthcare. Participants preferred daily SMS reminders (n=32; 82%) to reminders linked to missed doses (n=7; 18%), citing the fact that TB medication is taken daily.
CONCLUSIONS
The use of real-time adherence monitoring linked to SMS reminders, and Mobile Money incentives for TB medication was feasible and acceptable in a low-resource setting where poverty-based structural barriers heavily constrain TB treatment and care.
CLINICALTRIAL
ClinicalTrials.gov NCT05656287